Why are space-occupying lesions included in the differential diagnosis of migraine headaches?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Another concern is the possibility of a space-occupying lesion mimicking migraine. In a series of 111 patients with primary (34%) or metastatic (66%) brain tumor, headache was reported in 48%; the headache had characteristics similar to migraine in 9% and to tension-type headache in 77%, while the so-called classic early morning brain tumor headache occurred in only 17%. Headache was intermittent in 62%, usually lasting a few hours. [74]

All patients with headaches similar to migraine had other neurologic symptoms or abnormal signs. Of note is that 32% of the patients had a history of headache; in 36% of those patients, the headache was of identical character to prior headaches but was more severe or frequent and was associated with other symptoms, such as seizures, confusion, prolonged nausea, and hemiparesis. [74]

These data indicate that patients with a history of headache should have further diagnostic workup if the headache is accompanied by new symptoms or abnormal signs or differs in any way from their usual headache. With new-onset headache, imaging should be obtained if headache is severe or occurs with nausea, vomiting, or abnormal signs.

Other space-occupying lesions must be considered in the appropriate clinical setting. Large intraparenchymal hemorrhage presents dramatically with headache and neurologic symptoms or signs shortly after onset. Of patients with chronic, subacute, or acute subdural hematoma, 81%, 53%, and 11%, respectively, have headaches. In brain abscesses, a progressive, severe, intractable headache is common, and headache is reported in 70-90% of patients.

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